Strategic Context

Planning Context and Key Strategic Issues

The Ministry of Health operates within the broader economic, social, and environmental influences that affect the population’s health status. Enjoying good health and a high quality of life depends on many factors, including access to quality education, meaningful employment, stable family and community environments, and making healthy lifestyle choices.

Access to high quality health services also has a positive influence on health status. In British Columbia, citizens are supported in maintaining their health by a publicly funded health system, directed by the Ministry of Health and delivered primarily by B.C.’s health authorities and health care professionals. In the past 35 years, the scope of the public health system has expanded beyond traditional hospital and physician services to include comprehensive public health programs, a broad team of service providers, prescription drugs, home and community care and more.

British Columbians have a quality health system they can rely on and have some of the best health outcomes in the country. This is reflected in British Columbia’s report on nationally comparable performance indicators entitled Healthy British Columbia released in November 2004. The report gives a broad snapshot of the health system and the health of the population in B.C. using 2003 data from the Canadian Community Health Survey. The report indicates British Columbians have good access to health care, live healthier longer than other Canadians, are less likely to smoke than other Canadians and more likely than other Canadians to lead an active lifestyle. (The report can be found at http://www.health.gov.bc.ca/cpa/publications/index.html).

Challenges and Risks

The ministry must monitor broader societal indicators and trends to assess and plan for potential impacts on the health of the public and the health system. For instance, while British Columbians currently enjoy the best health status in Canada, there are worrying trends that are already creating unprecedented demands for health services:

• An aging population with a rising burden of illness is resulting in the continuing rise in demand for increasingly complex and expensive health services.
• Tobacco use remains the risk factor that most contributes to the burden of diseases in British Columbia.
• 42 per cent of adult British Columbians are overweight or obese according to self-reported data, and only 58 per cent are physically active or moderately active.
• The health care workforce is aging, and maintaining an adequate supply and mix of health professionals and workers will be challenging.

British Columbia’s population growth and demographic shifts are also putting pressure on the health system, as health services tend to be used at higher rates in older age groups. The following demographic trends help to illustrate the scope of the future challenges to the health system:

• British Columbia's population is growing; in 2005 the population increased by 42,700 persons and is expected to increase by 45,000 persons in 2006, 47,500 in 2007, and 48,500 in 2008. By 2010, the population is forecast to be 4,485,000, an increase of 5.9 per cent from 2005.
• The share of British Columbia’s population over the age of 65 is expanding. Relative to 2005, by 2015 the share of the population over 65 will grow by 24.4 per cent, from 13.9 per cent to 17.3 per cent. Moreover, the median age in British Columbia is expected to reach 42 years by 2015 from 39.6 years in 2005.
• Life expectancy is increasing. In 2005, the median age at death was 79 years and by 2015, it is expected to be more than 81 years.
• An 80-year-old today is twice as likely to have a knee replacement, coronary bypass, or cataract surgery as 15 years ago, and eight times as likely to have an angioplasty procedure.

Furthermore, maintaining a high quality health system is also challenged by a number of other factors in a rapidly changing environment. Those factors include:

• The development of new treatments for patients with conditions that were previously untreatable.
• The emergence of new diseases, which result in new tests, drugs and treatments.
• Public health emergencies such as avian flu, SARS, and West Nile Virus.
• The continuous need to update or expand health facilities, technology and equipment.

Capacity to Manage Risks

Government has annually increased funding for health services; however, funding increases alone will not meet the increasing and changing demands placed on the health system. As shown in this service plan, the ministry is undertaking many strategies to ensure the health system is able to adapt and respond to changing demands.

Our capacity to respond to change has been greatly increased through the development of an accountable, efficient and responsive health sector that welcomes the challenge of improving services for the citizens of British Columbia. One of our strengths is the streamlined structure of five geographic health authorities responsible for the delivery of health services within their regions, and one additional authority responsible for highly specialized services, such as cancer and cardiac care, province-wide. This structure is well designed to manage the complexity of the health system, take advantage of the ability to adapt to change, foster innovation and make strategic investments across the continuum of care. The British Columbia structure is responsive to the changing needs of the population and well prepared to meet the challenges of an increasingly diverse, growing and aging population.

The ministry and its partners across government and throughout the health system are also focusing efforts on innovative health promotion and disease prevention initiatives to keep the population healthy and mitigate some of the demand for health services. We are implementing programs to reduce the growth of chronic disease in the population by educating and supporting people to eat well, exercise and stop smoking. Also, for those already with a chronic illness, we are working with key stakeholders to improve the care they receive — by involving patients more in their care, providing evidence-based guidelines for physicians, and establishing collaboratives to share best-practice knowledge among providers.

The greatest untapped resource in health care is the consumer. Well-informed patients get better care from their doctors and provide better care for themselves. The issue at hand is how to get the right information into the hands of the right person at the right time. The development of a comprehensive self-care strategy that supports not only individuals but also health care professionals will take advantage of existing resources such as the BC HealthGuide Program and stretch across the continuum of care — from birth to coping with end of life matters. Our goal is to provide British Columbians with the appropriate tools and resources they need to make the right health decisions for themselves and their families.

In addition, the ministry is also engaging in longer-term planning and employing more integrated approaches to anticipating and meeting longer-term needs. The ministry has significantly strengthened its data collection and analysis capability, and developed a long-term planning framework that provides structured guidance to ensure health system planning activities are evidence-based and focused on population and patient needs. The improved data and the framework are guiding the ministry’s planning in key service delivery and infrastructure areas, such as health human resource planning, information technology (including eHealth) planning, and capital investment planning for facilities and equipment. Longer-term coordinated approaches based on evidence derived from sound data and analysis strengthens the ministry’s ability to make the right strategic investments to address the challenges facing the system, and deliver a quality health system now and in the future.